Apply OnlineWe consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.Position(s) Applied For:Locations Applying For (Select all that apply)Cairo Megaclinic (Cairo, IL)Cairo Diagnostic Center (Cairo, IL)Carmi Community Health Center (Carmi, IL)Cedar Court Clinic (Carbondale, IL)CHESI Administration Office (Carbondale, IL)Hardin County Dental Clinic (Rosiclare, IL)Hardin County Medical (Elizabethtown, IL)Harrisburg Community Health Center (Harrisburg, IL)Pope County Clinic (Golconda, IL)Pulaski Clinic (Pulaski, IL)Tamms Community Health Center (Tamms, IL)How did you learn about us?AdvertisementEmployment AgencyFriendInternet (Google, Search Engine, Etc)RelativeWalk-InOtherIf other, please specify:Personal InformationFirst Name *Middle NameLast Name *Street Address *Apartment, suite, etcCity *State/Province *ZIP / Postal Code *Phone *Email Address *Questions about yourselfIf you are under 18 years of age, can you provide the required proof of your eligibility to work? *YesNoHave you ever filed an application with us before? *YesNoHave you ever been employed with us before? *YesNoAre you currently employed? *YesNoMay we contact your present employer? *YesNoAre you prevented from lawfully becoming employed in this country because of VISA or Immigration Status? *YesNoProof of citizenship or immigration status will be required upon employment.On what date would you be available for work? *Work Availability: *Full TimePart TimeShift WorkTemporaryCheck all that applyAre you currently on “lay-off” status and subject to recall? *YesNoCan you travel if a job requires it? *YesNoEducation *Elementary SchoolHigh SchoolUndergraduate CollegeGraduate ProfessionalOther (will be asked to specify later)Check all that applyEducationElementary SchoolElementary SchoolElementary AddressElementary CityElementary State/ProvinceElementary ZIP / Postal CodeCompleted?YesNoYears CompletedHigh SchoolHigh SchoolHigh School AddressHigh School CityHigh School State/ProvinceHigh School ZIP / Postal CodeCompleted?YesNoYears CompletedUndergraduate CollegeUndergraduate CollegeAddressCityState/ProvinceZIP / Postal CodeCompleted?YesNoYears CompletedGraduate / ProfessionalGraduate / ProfessionalAddressCityState/ProvinceZIP / Postal CodeCompleted?YesNoYears CompletedOther EducationOther EducationAddressCityState/ProvinceZIP / Postal CodeCompleted?YesNoYears CompletedAdditional SkillsDo you speak, read, and/or write any foreign languages?YesNoI am able to SPEAK:FluentGoodFairI am able to READ:FluentGoodFairI am able to WRITE:FluentGoodFairSkills / TrainingDescribe any specialized training, apprenticeship, skills and/or extra-curricular activities:Describe any job-related training, received in the United States Military:Employment ExperienceStart with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities and/or other protected status.EmployerStreet AddressCityState/ProvinceZIP / Postal CodeTelephone Number(s)Job TitleEmployed FromEmployed UntilSupervisorReason for LeavingWork Performed:EmployerStreet AddressCityState/ProvinceZIP / Postal CodeTelephone Number(s)Job TitleEmployed FromEmployed UntilSupervisorReason for LeavingWork Performed:EmployerStreet AddressCityState/ProvinceZIP / Postal CodeTelephone Number(s)Job TitleEmployed FromEmployed UntilSupervisorReason for LeavingWork Performed:EmployerStreet AddressCityState/ProvinceZIP / Postal CodeTelephone Number(s)Job TitleEmployed FromEmployed UntilSupervisorReason for LeavingWork Performed:Additional InformationList professional, trade, business or civic activities and offices heldYou may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status.Summarize special job-related skills and qualifications acquired from employment or other experienceSpecialized Skills / Check Skills / Equipment OperatedMicrosoft ExcelMicrosoft WordMicrosoft Outlook (E-mail)NextGenScanningFAXCalculatorTypewriterProduction / Mobile Machinery (List):Other (List):State any additional information you feel may be helpful to us in considering your applicationHave you been informed about the requirements of the job for which you are applying?NoYesAre you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied?NoYesProvide a description of the activities in such a job or occupationReferencesNamePhoneStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeNamePhoneStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeNamePhoneStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeApplicant StatementI Agree to the following statements: * I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. Upload ResumeChoose FileNo file chosenDelete uploaded fileAccepted Filetypes: PDFSubmit Application
